In my altruistic medical practice, I`m often called upon called upon to give a second opinion on the management of all kinds of illnesses. This usually originates in friends and family, from all parts of the world. Though it does not give me any materialistic benefits, it does help me understand medical practice around the world, doctor and patient perspectives and most importantly people`s behaviours and attitudes. My `clientele` is usually well to do, educated, accomplished and sometimes well researched. Some are doubters, some have specific questions, some are pressurised by their peers and some do it as a prop before taking a final decision. I usually feel quite honoured and important and try to do a good job. Especially because some of the professionals I have looked up to and it is sometimes a unique opportunity to get into their minds. Since this process takes place online and over the telephone, this gives a unique opportunity of what health in the digital age would look like.
More often than not, I marvel at the pains that the doctor has taken to investigate and formulate a management plan and it is just a matter of reiterating something that someone has already said and explaining in a way that the client is most comfortable with. This is completely understandable because most patients due to anxiety or otherwise do not actually follow in details what the doctor is saying and it usually takes a more familiar professional (usually the General Practitioner) to explain what the consultation was about. Some are in shock and disbelief and though they do understand the gist, but fail to understand the right questions and thus need to be spoken to with a lot of tact. Though it is imperative that the client is taken into confidence, it does happen that a certain adverse report may set the client back and a lot of social factors do come into play and the mind begins to wander during the consultation resulting in lack of effective communication. I have no answers as to what is the best solution to this because as a doctor I have probably been guilty of my client not fully comprehending what the management essentially entailed, but I`ve always been blessed with an army of extremely skilled specialist nurses and a multidisciplinary team who have worked tirelessly behind the scenes and clients have been completely up to speed in the next consultation. Whether they have sought a second opinion or not is anybody`s guess.
The real test comes in the case of a conflict, when the client is completely dissatisfied with the opinion or outcome of a consultation. This scenario has multiple possibilities. One, when I am disagreeing with what the written and verbal communication from the client is. There are multiple ways of tackling this. The first approach is to try to gauge what was in the mind of the practitioner and what information and resources did the practitioner have both medically and socially before giving his opinion? What the local and accepted practice is? Whether the cause of the conflict is due to a certain bias of the client? The opinion needs to be balanced and mature taking into consideration multiple angles and proper reasoning for your views must be given. The best option (if possible) is to speak to the practitioner. Usually doctors are happy to speak to a fellow practitioner as then more scientific evidence can be discussed. In some cases of disagreement, I have found that though the opinion was scientifically correct, there has been some misunderstanding or there were some family or social issues that the doctor at the time was not aware of.
Though clients are a bit wary of reprisal from the doctor for seeking a second opinion. This is something normal and must not be discouraged. In fact, in most instances it gives credibility to a practitioner and his opinions. The contentious question of course is retention of clients. This an extremely delicate issue. The choice of a practitioner depends on multiple factors many of which are subjective. Sometimes it is difficult to comprehend why a client chooses a certain professional over other. But by no means that a second opinion should be denied to anyone.
Digital health has the propensity to facilitate a harmonious environment where clients can seek opinions transcending geographic barriers, discuss with people in similar situations, read and converse about people with similar experiences. Professionals on the other hand are able to seek advice, confer with other professionals and gauge the mood and opinions of clients in order to improve their practice and do their best for clients which is the ultimate goal.
One of the barriers that change in medical care is facing is an increased trust deficit between clients and healthcare professionals. Clients find it increasingly difficult to rely on the opinion of a single medical practitioner and often go in boundless doctor shopping and sometimes waste valuable time in beginning formal management. This is extremely disappointing because a trusting doctor-patient relationship is at the foundation of good healthcare. Most people however accept that though there are a few rotten apples, healthcare professionals on the whole aim to do a good job. The main antagonism is towards the delivery of healthcare where the main complaint is that far from it being a delightful experience, clients feel that they have not got their money`s worth. Because of this, there is extreme cynicism and suspicion every time a new form of management is suggested. People are scared to go to a medical practitioner and the thought of falling ill or developing a chronic ailment terrifies them more than falling ill. Unfortunately, patients do not have confidence in the services provided. Whether it is mere misperception or fact based on people`s experiences is anybody`s guess. Though major healthcare providers have gone on a patient contact and public relations overdrive, the fact is that nothing much has changed.
However, all is not lost, because on the question of remote management and algorithmic management of illness, most people are sceptical and want to speak to a real doctor for their problems, rather than speak to a computer. Secondly, since healthcare is a mandatory service for humans, there is a bigger and easier possibility that these problems can be rectified.
The most important bit of the approach is to convince people that we appreciate their concerns and we are genuinely interested in improving the client experience by first understanding where the misunderstanding is and taking proper steps to solve this and verifying whether we are successful. As healthcare personnel and providers, we need to be empathetic and use words which improve effective communication. The best start is to accept that there is a problem.
A robust traditional healthcare system with good mobile health support can make a good start. Currently, the perception of mobile health for some is that healthcare professionals wish to further distance themselves from patients. Though people do desire empowerment to an extent, there is also need of proper engagement. The fact that digital health and telehealth helps patients by avoiding unnecessary visits, but this by no means distances patients’ needs to be explained. In this regards smart business models need to be evolved often in conjunction with interested clients. This promotes transparency which is the most important desired element in medical practice.
Digital health improves continuous patient contact and intervention, which used judiciously can evolve a system that cares. On-demand education of patient and their relatives, step down care following hospital discharge and on the whole access to help 24/7 is the most desirable element of healthcare for the rich, poor, educated, not so educated alike.
People who can pay, always wish to pay, but do not wish to be taken for a ride. An ill person is vulnerable and has multiple anxieties and medical management is only one of them. We must assume that every patient is well connected and every advice, treatment or procedure is being scrutinized in various parts of the world in an instant. Effective communication and delivery of the correct information is the key. Healthcare professionals should be transparent and bold and stand scrutiny voluntarily to win the confidence of the people.
People are extremely knowledgeable and sometimes confused with the information overload these days. All they need is to be led in the right direction. Honestly, the time that I get to spend when I do not don the doctor`s coat and be with clients as people are extremely insightful and rewarding. People do not expect too much. All they need to see is the human in that coat. They are aware of the changes all set to sweep healthcare with the advent of better algorithms, supercomputers, AI, Deep Learning. Some of them are even involved in building some of these. But currently, technology needs a gradual introduction, because the climate needs to change and the air needs to be cleared.